Don’t get me wrong, when I have a piece of paper that tells me when something is off- that is wonderful. Lab values are useful in the evaluation of disease and the monitoring of treatment. But, and this is a big but, laboratory tests are not supposed to be a doctors first line of gathering information.
Medical labs are more common place than physical exam in many medical offices these days. I am not sure if this is because of insurance dictating time, or our over reliance on something “smarter” than us to diagnose disease.
I would never dispute that it is good practice to run labs as a way to evaluate the function of systems in the body, such as electrolyte balance, adequate iron levels in blood, liver health, kidney excretion/function, cholesterol values, thyroid production, etc.
My issues lie here:
- A medical history holds very little weight compared to fancy medical equipment (“Medical equipment is better at diagnosis”)
- If the lab work is normal, then everything is fine…..no matter if you have symptoms or not (aka it is all in your head)
- We wait until people have a disease through an abnormal lab value to do anything about treatment……the very opposite of prevention
Ok, first, signs and symptoms, as well as past medical history of the patient and family, are just as important if not more so, than lab values. Oh, and yes, physical exam holds1/4 of that pie.
I think we have forgotten the purpose of laboratory tests: to verify what is suspected in the clinical setting. When you take a look at this image from labtestsonline.org about how diagnosis of disease occurs, you see that medical tests is ¼ of the pie.
Second, people have symptoms all over the place and often come to me with no “positive” lab values pointing to a definitive dis-ease. Yet they are tried, constipated, experience reflux, bloating, have frequent swelling in their feet, skin rashes, swollen lymph, sleep difficulties, etc, etc. Yet, all the regular lab values are normal. So what do you do……(hint: treat the systems, not the symptoms!)
This leads me to my third hesitancy with our over reliance on laboratory tests: we WAIT until someone has a full-blown disease to treat them. Oi vey!! Really. I am going to say this again- we wait until the disease shows up on the laboratory tests before we start ANY treatment.
Let’s get a better analogy going here- so you drive a car and your break pads wear down. Instead of replacing your break pads, which cost very little and prevent your rotors from being damaged, you wait and wait and wait. Before you know it, your steering wheel now regularly shakes when you press on the brakes. You guessed it, you have to get your rotors replaced because not only do you have no pads left, but the rotors are warped. ‘Uh oh,’ as my daughter so eloquently declares. The brake pads are our daily health promoting habits, which keep the rotors (our body) safe and well protected. When we don’t take care of our brake pads, then the rotors are damaged causing a much larger problem. A problem that is not as easily reversible.
So, yes, lab values are great to uncover and monitor treatment, BUT they are not the be all end all of understanding what is going on for someone. So, go ahead get those lab values, but make sure your healthcare provider is working with the full picture. And if the labs come back negative…..find someone who can help you restore health to your systems!